Charlie Sheen is HIV positive. As was revealed on the Dr. Oz show, when diagnosed his viral load was 4.4 million. After six months of the a standard anti-HIV cocktail his viral loads were undetectable.

This does not mean he is HIV negative or free of this virus. As part of the viral life-cycle it goes into hiding inside of cells. It is undetectable while hiding, and also cannot be eradicated by medications. This is a major challenge to curing HIV, or even pushing the efficacy of our current treatments further. Researchers are looking into ways to force the virus out of hiding so that anti-retroviral medications can go to work.

With current anti-HIV treatment someone who is HIV positive can expect to live an almost normal life expectancy free of any major complications of the disease and will not go on to develop AIDS from the virus. The big challenge now is to get this modern medicine to those who are HIV positive in the third world, or to those who cannot afford it.

Interestingly, Charlie Sheen, who has all of the advantages of wealth in a Western industrialized country, opted for third-world treatment of his HIV. He recently went off of his anti-HIV medications and instead decided to rely on the ministrations of an unknown doctor in Mexico making bold claims.

This prompted an on-air intervention by Dr. Oz and Sheen’s own doctor (which was ethically dubious but good television, I guess), after which Sheen reported he would go back on his medications.

Of course, most HIV patients who are lured to Mexico with the promise of a miracle cure will not benefit from a personal intervention by Dr. Oz. Hopefully they will benefit from watching that episode, but if history is any guide (unfortunately) the exposure is likely to lead more people to the Mexico charlatan than warn them away.

Why People Seek Charlatans

The Sheen episode raises a fascinating and important question – what is the allure of the lone maverick making bold claims? Often the answer provided is desperation, but what makes the Sheen example so interesting is that desperation was not a factor. He was effectively in remission from his HIV with undetectable loads. He still has to take medications for the rest of his life, but that seems a small price to pay for taking a horrible deadly disease and transforming it into a benign chronic condition with a normal life-expectancy and quality of life. The situation did not call for desperation.

Psychologists have found that people fear losing out on a possible benefit more than they fear losing something they already have. This is why people play the lottery, spending real money for an insignificant chance of winning a lot more. They will take risks and spend resources for the possibility of gain. In this case Sheen was willing to risk his health and his life for the possibility of a small benefit – not having to take medications.

Successful professional gamblers learn to control this urge. They learn to play the odds, rather than their hopes. They have to suppress their natural instincts and play by the numbers. Medicine is also a game of probability, and that is the role of the doctor, to help patients make optimal decisions based upon the evidence, not make statistically bad decisions based upon their hopes.

There is more to it than just this aspect of human psychology, however. Charlatans are like magicians, over the centuries they have honed their craft through trial and error, emulating those who are successful. They know how to manipulate emotions, how to manipulate those in power, and how to work the system.

This HIV quack (who also claims to have the cure for cancer) knew exactly what he had in Sheen – a celebrity meal ticket. Unfortunately, I do think Oz played into his hands by giving him exposure, even if it was negative.

The Mexican doctor used a few tactics that are very common. First, he covers his treatment in the patina of science. He told Sheen that his treatment was based on patented technology and based on published science. Of course, the only published paper he cited was from 20 years ago, and this line of research was abandoned because it did not work.

Most new ideas in science and medicine do not work out. They do, however, create a huge reservoir of plausible but failed hypotheses, with preliminary encouraging evidence. If you ignore the fact that the hypothesis ultimately failed, or has not yet been fully studied, it makes for a great con. It is a pre-packaged pseudoscientific narrative.

A non-expert has almost no chance of sorting this out on their own. You have to be familiar with the science and the research. You could, of course, just listen to the experts, but con artists divert their marks away from the experts with claims of conspiracy, vested interest, hidden cures, closed-mindedness, and industry influence. Those narratives come pre-packaged also.

Apparently this quack also pulled a dramatic stunt – he reports that he injected Sheen’s blood into himself, to show him how confident he was that Sheen was cured. No reputable doctor would ever do this. This was a clear stunt, and only demonstrates how desperate the con artist was to convince his celebrity mark. He knew what was at stake – and it worked.

In addition he claims lab tests that show Sheen is HIV negative, and claims the first cure of HIV in an adult. Without independent verification, this is worthless, of course. Fake lab tests are all just part of the con.

Another part of the psychology here is that people want to feel that they are one-step ahead of the herd. Getting standard treatment available to everyone just seems so mediocre. If, however, you do “research” and find that there is a reported better option, that you can get a treatment that is safer or more effective than the regular treatment, that has a huge appeal. You can congratulate yourself on your cleverness and ingenuity, your open-mindedness, and your wisdom in seeing how corrupt the system is. You are not only one of the enlightened few, you will use your knowledge to cure yourself.

This view also creates a massive disincentive to ever admit that you were wrong. Admitting error, even when the disease that could have been cured or managed by modern medicine is now ravaging your body and killing you, is just too difficult. You would have to abandon your entire self-image. You would have to admit that you were not being clever, wise, and open – just naive and desperate.

Con-artists know this and count on it.

Conclusion

The Charlie Sheen episode is a teachable moment. I do hope that it helps get the word out that modern anti-HIV treatment is effective, and should not be abandoned for the equivalent of magic beans.

It is also an opportunity to spread awareness of the psychology of con-artists, especially medical con-artists. Sheen is not stupid or crazy, he is just an average person. He was vulnerable to the promises of a quack in the same way that everyone is vulnerable.

Scientific literacy helps, but honestly it takes a pretty high degree of such literacy to counter a sophisticated con. Critical thinking and skeptical knowledge are needed, knowing how con-artists work, how they try to manipulate people.

Perhaps the most useful take-away is not to let the con-artists turn you against the experts, the very people who are in the best position to give you advice, the advice you need to understand that the con-artist is a dangerous quack and not your savior.

221 Responses to “Charlie Sheen’s HIV Quack”

“Apparently this quack also pulled a dramatic stunt – he reports that he injected Sheen’s blood into himself, to show him how confident he was that Sheen was cured.”

What happens to infectiousness levels when medication has pushed viral loads down to undetectable levels? I’m just wondering if the quack might have used blood drawn while Sheen was still fully medicated, and if this would actually present a minimal risk.

There are no studies testing blood transfusion that I am aware of, but there are a few studies now on serodiscordant couples who engage in unprotected intercourse, but where the positive person is on HIV medications and undetectable. In these studies transmission tot he negative partner was highly improbable to not a single case of transmission over the course of the study. Here is a decent summary:

Undetectable viral load makes risk of transmission (infection) almost precisely zero. I’m surprised Dr Novella didn’t home in more on this crucial aspect of the story. Not only was Sheen putting himself at risk by going off his meds, he was putting others at risk, too (e.g., sexual partners). In this way, Sheen, the “Mexico charlatan,” and others who encourage ART refusal are no different than antivaxxers who put others (not just their children) at risk by refusing vaccines.

I have a tangential question to this interesting post. Given that HIV is relatively well contained, why is NIH still earmarking such a high percentage of funds for its study? The urgency isn’t there like it was when everyone was dying of AIDS, so why is the funding still so disproportionately high? I have friends who work at NIH who say that it is all politics, that you will get slaughtered politically if you suggest this, but is there something more to it than that?

Cancer is way over-funded, while things like heart disease and COPD are way underfunded. ALS is way over-funded. Autism is way over-funded. Funding for infectious diseases went way up with the Ebola scares.

I think it is more plausible that the quack utilized slight-of-hand to pretend he injected himself with blood. Dr Novella is correct, no one with any expertise or credibility would do this. There are all sorts of reasons other than HIV to not inject blood from someone else into you.

If the quack has a treatment, why not do clinical trials with it? HIV testing is easy to do, there are blood tests that are very sensitive. If he has the marketing skill to get high profile marks like Sheen, he has the marketing skill to get a clinical trial funded and done.

Oz, 55, shared part of an audio conversation he had with Chachoua, who revealed he was so confident in Sheen’s treatment that he injected some of the actor’s blood into himself.

“I drew some blood from him and I injected myself with it and I said, ‘Charlie, if I don’t know what I’m doing, then we’re both in trouble now aren’t we?’ ” Chachoua told Oz by phone.

Chachoua made sure there would be no doubt that he does not know what he is doing.

Even though what Chachoua did was totally nuts, it doesn’t sound like a blood injection. What Charlie said was “I had a lump on my elbow that I had drained about a week prior to that and a little bit was still there so he pulled some out of that and he stuck it in the top of his forearm.”

Fortunately for people who do not know what they are doing, HIV is not that infectious.

Infectivity estimates following a needlestick exposure ranged from 0.00 to 2.38% [weighted mean, 0.23%; 95% confidence interval (CI), 0.00–0.46%; n = 21]. Three estimates of infectivity per intravenous drug injection ranged from 0.63 to 2.4% (median, 0.8%); a summary estimate could not be calculated. The quality of the only estimate of infectivity per contaminated medical injection (1.9–6.9%) was assessed. Instead we propose a range of 0.24–0.65%.

Although the estimated transmission rates in Uganda are higher and other data suggests

The median transmission risks for unsafe intravenous or intramuscular injections using equipment cleaned but not sterilized after use on a symptomatic pre-AIDS patient are 1.8% (95% confidence interval [CI] 0.1–3.2%) and 0.8% (95% CI 0.1–1.4%), respectively.

An intramuscular injection of a non-bloody body fluid, or even blood, from a patient with an undetectable viral load is unlikely to transmit HIV. Assuming he pushed the plunger.

So while Dr. Chachoua has alternative judgement to match his alternative therapies, fortunately for him he is unlikely to get HIV from Mr. Sheen. Not that we will ever know.

HIV couldn’t have happened to a “nicer guy”. Sorry to be so harsh, but Sheen is a despicable human being. I do hope his claimed reversal on the quack situation becomes a good example for others. If so, Sheen’s life will not have been a total, embarrassing waste. Gifted with a “good” name, a head start given to very, very few, and he wastes it all. It makes me wish that Hell is a real place.

“Apparently this quack also pulled a dramatic stunt – he reports that he injected Sheen’s blood into himself, to show him how confident he was that Sheen was cured.”
What happens to infectiousness levels when medication has pushed viral loads down to undetectable levels? I’m just wondering if the quack might have used blood drawn while Sheen was still fully medicated, and if this would actually present a minimal risk.

~
He also could have completely faked it. Swapped out the needles in some clever way.

“An intramuscular injection of a non-bloody body fluid, or even blood, from a patient with an undetectable viral load is unlikely to transmit HIV. Assuming he pushed the plunger.”

Yeah, it is hard to imagine that he actually did that when faking it is so much less crazy. But even if you thought the risk is near zero (I wouldn’t be so confident if it were me), you’d still take the post-exposure prophylaxis, wouldn’t you?

“This means that average life expectancy at age 20 was now equal to US men in the general population, among heterosexual people with HIV and in white people. It was also a remarkable 69 years at age 20 in gay men and people starting ART before 350 cells/mm3 – meaning that, if nothing else changed, these groups, as long as they stay on ART, have a 50/50 chance of seeing their 89th birthday – a full seven years longer than women in the general US population.”

“Nearly 50 percent of people infected with HIV will eventually develop some form of brain damage that, while mild, can affect the ability to drive, work or participate in many daily activities. It has long been assumed that the disease was causing the damage, but Hopkins researchers say the drug efavirenz may play a key role.”

Actually, even if he were already HIV positive there still could be significant consequences. There are multiple groups and subtypes of HIV, and being infected with multiple strains is not good. It can increase disease progression and increase the likelihood of treatment failure.

An intramuscular injection of a non-bloody body fluid, or even blood, from a patient with an undetectable viral load is unlikely to transmit HIV. Assuming he pushed the plunger.

A rather big assumption, knowing the overlap between alternative medicine people and sleight-of-hand artists. Given the kind of tricks that SCAM people have gotten away with in the past, swapping syringes would likely have been so easy that it wouldn’t even take any practice.

I am sure that the mainstream AIDS consensus is terribly over-simplified. No one wants to admit that they don’t understand. They probably fool themselves into thinking that they do understand. Ok that’s just human nature.

But what I find appalling is the way ARV drugs are being sold. Maybe there are occasions where they keep someone alive for a while, but I am sure that the vast majority who take them are being seriously damaged for no good reason.

The science behind the AIDS consensus is weak. No I don’t agree with the deniers either. But if you really look into this and trust yourself, even though you are not an expert, you will see how shaky the foundations of this enormously profitable enterprise really are.

But it is possible to distrust CAM and to also distrust the mainstream consensus. That is, supposedly, why we are here. To distrust our own fallible human minds and the fallible human minds of others, even the experts who dominate our society.

The idea that killing HIV with ARVs is the answer to the AIDS problem is an over-simplification, and I don’t think it will ever lead to a cure.

We have an illusion of great success. If you assume that most HIV infected people will eventually get AIDS, and you believe that ARVs can prevent AIDS, then it looks like millions of lives have been saved.

However the idea that HIV usually progresses to AIDS has not been tested. They have not been able to infect animals with an HIV-like virus that causes the animal to have AIDS.

They also have not been able to prove that HIV alone is sufficient to cause AIDS.

I believe that AIDS can be an infectious disease and I believe that HIV is somehow involved, but that’s all we know about it.

Even though the disease course of HIV/AIDS is quite well described in the literature across thousands and thousands of patients over decades and the treatments are clearly effective from clinical trials, it’s obviously imperative we design a natural history study where we tell people they’re perfectly fine with no need to worry and withhold therapy from them so we can reach some arbitrary threshold of knowledge.

It is not possible to do the experiments that would help answer the central questions. The best alternative would be animal models but these have not been found. Why not? Is it possible that HIV alone cannot cause AIDS?

What if most people with a positive HIV test would never get AIDS? If that is the case, millions of people are subjected to highly poisonous substances that accelerate aging, cause serious chronic diseases, and can cause fatal diseases.

The questions should at least be considered but they are not. Anyone who doubts any aspect of the HIV/AIDS theory is called a denier and discredited.

By the way I very much disagree with most of the deniers, because they say that AIDS is not an infectious disease, when it obviously is. They also claim to know the real causes of AIDS, when obviously they don’t.

Sometimes admitting we don’t know is a critical step in finding real answers. If you think you already know, you will stop looking.

If you’re sincerely curious, in untreated patients around 2% of people seem to maintain good CD4 levels (depending on how consistency is defined) and ~0.6% of people with HIV are able to maintain undetectable viral loads; there’s some overlap between these groups, but there are people who only feature one or the other. These follow-ups are for around 10 years, so the numbers shouldn’t be interpreted as people who are ‘immune’ to developing AIDS. Importantly, that 2% number at 10 years follow-up was 3% at 7 year follow-up.

Excellent! This gives me something to work with. So you’re familiar with (or at least, have ‘seen’) the natural history cohorts and the research around them and you were able to assess they were not “good” by your standards. Before we go over this cohort in particular (I like because it’s a large sample and diverse US population), maybe you should link some of the cohorts or analyses you used to make your decision. This would allow me to know ahead of time if the study I’m using is not “good” and that way we won’t waste each others time.

People in Africa are not likely to get an HIV test if they have no symptoms.

A big problem with all the AIDS research I have seen is that more healthy people are getting HIV tests now and being diagnosed with HIV/AIDS. This causes the death rate from AIDS to automatically decrease and the “successful treatment” rate to dramatically increase.

In the early days of AIDS no one was diagnosed with AIDS unless they had AIDS symptoms. Now the diagnosis depends on HIV levels and CD4 counts.

Well I would like to know where that data is? I have really looked and did not find it. I know there is a correlation but could not find any demonstrations of causality, especially not of sufficient causality.

“Well I would like to know where that data is? I have really looked and did not find it. I know there is a correlation but could not find any demonstrations of causality, especially not of sufficient causality.”

You still haven’t explained your reasoning as to why untreated HIV cohorts have such extremely low rates of not developing AIDS. If HIV does not lead to AIDS, you should have a pretty lock-tight explanation as to what is confounding this finding. Just a reminder that we’re waiting.

“Not being able to do the decisive experiments does not mean you can draw conclusions from poor data.”

There is a preference for experimental design over observational, but the absence of a hypothetical “One True Study” does not mean all observational data can simply be ignored. Again, this is identical to the tactics that (amusingly) both anti-vax groups and the tobacco industry share. A large body of observational data approaching a question in several ways can allow for inferred causality, or at least provide enough of an explanation that “I don’t like this study” is no longer sufficient.

Also, just to clarify – while the original AZT study did have some issues (the blinding is questionable) and it’s true that a lot of current drugs focus on non-inferiority designs – you are aware that many other anti-retroviral drugs also went randomized controlled trials, right? You seem to be implying none of these studies exist, but they are easily searchable on pubmed. You’ve already demonstrated you don’t know what you don’t know when it comes to HIV research (unaware there are natural history studies) – I would hope you would be a bit more cautious treading forward instead of continuing to charge forth with ignorance as a shield.

It has been a while but I did read everything I could find about HIV/AIDS. Not because I know anyone who has it, but because I became fascinated by the confusion and possible deception.

This is based on memory:

The first AZT study was brief (less than a year) and was discontinued because AZT seemed to be effective.

Subsequent studies compared AZT to newer ARV drugs. Since AZT is highly toxic, it is possible for less toxic drug outcomes to compare favorably. That does not mean the drug is effective, just less destructive than AZT.

Maybe AZT and other ARVs actually help AIDS patients, but in my opinion we can’t know from the existing research.

There are various possible confounding factors that ARV enthusiasts ignore. For example, ARVs are known to have antibiotic effects on some AIDS-related infections. That would make it seem like the drug is fighting AIDS even if it is only fighting related infections.

There are many open questions and not many good answers.

The experts who are in charge have rushed to promote ARVs for every HIV positive person, and even for HIV negative people who may be at risk. This is a grave mistake, in my opinion, based on what I know so far.

And you can’t compare AIDS in Africa to AIDS in the US since they might not even be the same disease. And health conditions in some parts of Africa can be very poor. It simply is not a fair comparison.

Another problem is that ARV drugs can cause cancer, diabetes and heart disease. When HIV patients die from these diseases it is often blamed on age, even though the drugs are known to cause them. It is difficult or impossible to know whether an HIV patient who died from cancer or heart disease actually died from ARV poisoning.

There are other RCTs for ARVs besides AZT that are placebo controlled. The drugs work drastically better than placebo, period. Try again.

I ask again: You still haven’t explained your reasoning as to why untreated HIV cohorts have such extremely low rates of not developing AIDS. If HIV does not lead to AIDS, you should have a pretty lock-tight explanation as to what is confounding this finding.

Adding to this, we have a good body of research on what happens when patients do not adhere to their medication regimen (especially falling below 50% compliance) – guess what happens? You can make a really good prediction about who will get AIDS based on their medication compliance. Why is that, since apparently HIV does not cause AIDS and ARVs don’t work?

“Another problem is that ARV drugs can cause cancer, diabetes and heart disease”

Interesting use of language. So you’re absolutely positive HIV does not cause AIDS, but you are absolutely positive that ARV drugs cause cancer, diabetes, and heart disease – even though the data to infer causality is much stronger for the former rather than the latter.

Also, ARVs as a whole do not cause cancer, diabetes, and heart disease. Specific ARVs have these associations. This might surprise you, but in 2016 we don’t put people on huge doses of AZT four times a day. It might help you to familiarize yourself with the categories of medication that are used today for treatment naive patients and why they are used.

In the early days of AIDS no one was diagnosed with AIDS unless they had AIDS symptoms. Now the diagnosis depends on HIV levels and CD4 counts.

Could you clarify what you mean by this … specifically “AIDS symptoms?” AIDS stands for acquired immunodeficiency syndrome Low CD4 counts, below a particular threshold, after assessing data from thousands and thousands of patients show, define immunodeficiency here. Which is a symptom. I really don’t understand what you’re writing.

People in Africa are not likely to get an HIV test if they have no symptoms.

That is patently untrue. Not all of the entire continent of Africa is a wasteland of void of screening sites. Believe it or not, there are people in the U.S. who get an HIV test with symptoms from the flu-like symptoms of acute/early infection to opportunistic infections; as well as healthy people who get tested because they want to.

If you define AIDS in terms of HIV and CD4 levels, rather than AIDS symptoms, that will automatically lower the death rate.

And I never found any evidence that lowering levels of HIV correlated with better health.

Boy howdy. You really could just start with going to Pubmed.gov – select “Books” from the dropdown menu, and type in “HIV” in the search field. Find anything that strikes your fancy and start reading. For the basics on the type of virus that HIV is … and how it causes the death of CD4 cells … and how that leads to immunosuppression (the major featuring defining the constellation of symptoms for the disease known as “acquired immunodeficiency syndrome”), and how the various types of ARTs work to inhibit replication. Really. Just read one book.

I think it would be educational to read stories of people who have lived a long time with HIV. Do the wonderful new drugs really allow HIV patients to live almost normal lives?

Unless you are a recluse, it is highly probably that you know many, many, many people who are. But just don’t tell you. I can’t count how many friends and family I know fit this description. And it is not “almost” normal, they live totally normal lives. I almost feel sorry for you because you don’t realize how offensive this question is.

Well, if we’re going to decide this question on anecdotes, here’s one from my personal experience:

I have a friend who went for a holiday to Thailand where he met and married a local girl. She had a young daughter and son and the four of them moved back to Australia. Within months she died from cerebral complications of HIV, having had no treatment for her infection. She of course knew of her HIV status and wanted a ticket to a better life for her son and daughter. My friend tested positive for HIV and has been on ARV therapy ever since. That was about twenty years ago and he remains unaffected by any of the complications of HIV.

Of course anecdotes are worthless – except to a science-denying Altmed nutjob who cherry picks his way through the anecdotes, as he does the clinical studies, to arrive at his starting point, which is that his personal experience and knowledge ranks far above that of recognised experts in field.

“You do not know what would have happened if he never had ARV therapy.”

Yes, we do, there’s at least a 98% chance he would develop AIDS within 10 years.

I would not go to Vegas on those odds.

“I have read A LOT about HIV”

Guess what? So have I and so have “the experts” you despise. And yet, you are totally unfamiliar with natural history cohorts and their outcomes…

No one cares that HIV research has not reached some arbitrary threshold of knowledge you demand. You could literally make this flimsy article about any field of research, it’s why every study ends with the platitude “more research is needed” – it’s simply not profound.

You always take the easy way out and sit back and criticize every single study and demand that we acknowledge your mantra that because we don’t know everything we don’t know anything. You are rarely in a position where you have to actually build a case for yourself other than simply spreading fear, uncertainty, and doubt. You should try to play the opposite role one day and actually have to defend something and make a case with evidence.

edamame “Given that HIV is relatively well contained, why is NIH still earmarking such a high percentage of funds for its study?”

This is an interesting case where political activism met science. In the 80s, the HIV epidemic was ignored by the culturally conservative groups in control of the government. But after lots of activism, including a major roll of journalists, there was written into law a congressional mandate to set aside funds for trans-NIH (available to all the institutes) research administered by the Office of AIDS Research. As you note, the efforts are largely successful and the NIH funded community largely agreed with your sentiment. However, the when it is Congressionally mandated, it has to happen. So as far as the politics go, that’s where it may be coming from. NIH staff can’t talk about what congress should and shouldn’t do, and they can’t undermine their own authority by grumbling about their opinions (be they scientifically informed or not). With that said, I read on the grapevine that the new budget took this mandate out by changing a few words, I haven’t had time to dig into the details yet. The office of the director just put out their new stratetic plan (haven’t had time to read that yet either). Phasing out the “over funding” of HIV research may take some time, long-standing programs will need to be restructured, the Office of AIDS Research might need to be phased out, the extramural grants are 5-year commitments, with potential for competitive renewal (and the NIH is beholden to the whims of peer reviewers in some respects). It’s a slow-turning ship.

“The AIDS death rate was very high when the diagnosis depended on actual AIDS-defining diseases.”

Those “defining diseases” we’re opportunistic infections. You are missing the underlying fact that those patients in the 80’s with what you are incorrectly labeling as having “AIDS-defining diseases” also had very high HUV loads and low CD4 counts. You are not arguing based on new or updated information. name that logical fallacy, anyone?

Having low CD4 counts (or a low CD4/CD8 ratio) is immunodefiency, it is a symptom. Are you advocating to wait until someone developed opportunistic infections before initiating therapy? This is called delayed treatment, and has been tested in clinical trials and shown definitively to have worse health and mortality outcomes compared to early therapy for HIV infected persons.

I am not advocating anything. I am saying that being diagnosed with AIDS now versus in the 1980s has a different meaning. An AIDS patient today might be healthy, whereas AIDS patients in the 1980s were all sick (or they would have have been to the doctor and received the diagnosis).

So now AIDS patients are a mixture of healthy and unhealthy, and on average they will do better than AIDS patients in the 1980s, when all were sick. But this average is meaningless.

We really do not know how much, or if, ARV drugs promote health.

The claim that AIDS is no longer a serious illness is not based on any good evidence.

I know people see banning as a distasteful solution, but I say it’s time to consider.

I have several times advocated not feeding the troll only to go back myself, so I can speak to the fact that this is difficult . It’s part of the skeptic’s makeup to try and engage, but now you have someone who is purposefully not engaging and is clearly here just to press our buttons.

Also, there’s a transmission argument. That tiny fraction of people (ranges from 0.2 to 5%) who are long-term non-progressors can still transmit to other people. So the decision to say they don’t “really” have HIV and there are no consequences to their status has an obvious public health detriment.

“Are you advocating to wait until someone developed opportunistic infections before initiating therapy?”

To be fair, HN never advocates for anything – except that fact that science is more complicated than the peasants think and that he is really, really smart for recognizing it. The court jester is not there to debate, but to entertain.

The challenges of treating actual medical conditions in the real world where decisions have to be made, sometimes with not perfect data, is a burden he doesn’t have to carry as a computer programmer. If placed a situation where a patient presented with an HIV patient and he was responsible for their care, HN would just say their disease is really complicated and that he sure hopes they won’t get AIDS. Completely true, and completely useless.

“Why do patients untreated with ARVs progress from HIV to AIDS, if HIV is not the cause of AIDS and ARVs do not work?”

It often happens that patients with a positive HIV test get AIDS. We don’t know how often patients with HIV do not get AIDS. It would be very difficult to find out.

I said that ARVs can work because they may fight off AIDS-related infections. I do not think they work by lowering HIV levels. ARVs may cause HIV levels to decline, but they also cause many other things to decline.

Patients who are treated with ARVs can also progress from HIV to AIDS. We can’t compare what happens when HIV patients are or are not treated with ARVs so we can’t know how often ARVs actually prevent AIDS.

The historical data does not tell us, since there are many possible reasons for the declining AIDS death rate. For one thing, more people are now aware of how to avoid catching it.

The death rate also declined when the use of AZT declined.

There are too many confounding factors to draw the simple conclusion that ARV drugs prevent the progression from HIV to AIDS.

“that science is more complicated than the peasants think and that he is really, really smart for recognizing it.”

That is the opposite of my point of view. I think the “peasants” are just as smart as the experts and authorities and I would like to see people respect themselves more and respect the experts less. In other words, be real skeptics.

We do, there are natural history cohorts. I thought your PhD meant you were really good at doing research?

“I said that ARVs can work because they may fight off AIDS-related infections.”

Hi, people with HIV do not have AIDS-associated infections until they have AIDS. People do not progress from HIV to AIDS because they are getting infections. Saying antivirals are really antibiotics is not an explanation.

“Patients who are treated with ARVs can also progress from HIV to AIDS”

Which is odd, because the ones that do are the ones most likely to be non-adherent with their medication regimen. If ARVs don’t help prevent the progression to AIDS, I wonder why that is. Do tell?

“Why do newborn children who get HIV from their mothers, and thus are not exposed to any other environmental risks, develop AIDS?”

I already said, several times, that I believe AIDS is an infectious disease. And that HIV correlates with it. So anyone who receives blood from an HIV infected person could catch HIV and AIDS. That says nothing about whether HIV actually causes AIDS>

Also, just so I am abundantly clear for people who might be reading this discussion at some point:

I am 100% comfortable relying on cohort data for this question (what happens to untreated patients with HIV and how many people progress?) as there is a large body of corroborate evidence to clear up the open questions. I explicitly reject HN’s criteria that we “can’t know for sure” until we do a randomized test in which we subject half the patients to contract HIV and see what happens – I’m curious, but I’m not so curious I would under any circumstance be willing to torture humans to prove I am irrefutably correct.

Experimental data is great, but there is nothing wrong with using observational data to answer questions that can be answered with observational data.

hardnose – regarding that study, you left out the fact that it dealt with a population where kids were often suffering malnutrition and other life-threatening factors, it followed kids from whenever they happened to start treatment (usually when symptoms were well advanced), it didn’t compare life-long HAART users to life-long non-HAART users.

And you left out this bit of the abstract: “The incidence of death was 5.1/100 person-years in the non-HAART group and 0.8/100 person-years in the HAART group (p < 0.0001)" And that was on top of the fact that the study explicitly said that on average the patients presented for HAART showed more severe symptoms at the start of their therapy.

Finally – nowhere in the study did anyone say a "normal life".

How should we interpret your blatant (and lazy) cherry-picking, strawman-bashing and quote-mining? Is it due to over-zealous advocacy? An inability to comprehend what you read? Or just fundamental dishonesty?

You talk about doctors and pharma companies that distort data to present the outcomes they want rather than presenting what is really happening. Yet you enter a discussion with your pre-defined narrative, you will not be moved from it, and you will cherry-pick and strawman and duck and dodge and throw intellectual integrity to the wind in your defense of your narrative. In your own petty little way, you do EXACTLY what you accuse others of doing – you just do it on a very small scale. At least the medical field attempts to self-correct (Cochrane reviews, trial registries, introspective studies). Why don't you?

Or is your mission, as I believe, simply to disrupt and degrade these discussions?

Science-denying Altmed nutjob who cherry picks his way through the anecdotes, as he does the clinical studies, to arrive at his starting point, which is that his personal experience and knowledge ranks far above that of recognised experts in field.

No RickK, I WANT someone to show me I’m wrong about the AIDS industry. The impression I have so far is sickening. I hate to think of all those people taking poison drugs that have little or no benefit. I hate to think of all the money Bill Gates is pouring into it. And yes, I’m sure he thinks he really is helping the world.

If there is evidence that HIV really is the sole cause of AIDS, and that ARV drugs really are the answer, or the potential answer, then someone should be able to show it. I have not seen it in over 100 comments here so far.

See, there’s three kinds of people: d1cks, puss..s, and a..holes. Pu..ies think everyone can get along, and d1cks just want to f.ck all the time without thinking it through. But then you got your a..holes, Chuck. And all the a..holes want us to sh1t all over everything! So, pssies may get mad at d1cks once in a while, because p..sies get f.cked by d1cks. But d..ks also f.ck assholes, Chuck. And if they didn’t f.ck the assholes, you know what you’d get? You’d get your d1ck and your p..sy all covered in sh.t!”

See, there’s three kinds of people: d1cks, puss..s, and a..holes. Pu..ies think everyone can get along, and d1cks just want to f.ck all the time without thinking it through. But then you got your a..holes, Chuck. And all the a..holes want us to sh1t all over everything! So, pssies may get mad at d1cks once in a while, because p..sies get f.cked by d1cks. But d..ks also f.ck assholes, Chuck. And if they didn’t f.ck the assholes, you know what you’d get? You’d get your d1ck and your p..sy all covered in sh.t!”

What HN wants to know is irrelevant. Why HN wants to know it is completely relevant. Answering the “what” results in a never ending cycle of feeding the troll; understanding the “why” enables us to end this cycle:http://rationalwiki.org/wiki/Wedge_Strategy

Key Points:
HIV infection causes AIDS
Some individuals show natural immunity to AIDS – these are being studied intensively for more effective therapy options.
Lifespan of HIV-infected people is dramatically increased with ARV therapy
HIV transmission is dramatically reduced with ARV therapy

I will give some credit, we made it 100+ comments and so far nothing about materialism or they need to think about the meta-physics of HIV/AIDS and the implications for dualism theories of infectious disease.

“What HN wants to know is irrelevant. Why HN wants to know it is completely relevant. Answering the “what” results in a never ending cycle of feeding the troll; understanding the “why” enables us to end this cycle:”

I think what’s most telling is there is no alternative hypothesis provided. The theory that currently explains all the observational and experimental data while introducing the least amount of assumptions is that HIV causes AIDS. HN can not be satisfied with the science (a lot of which he is unfamiliar with – like natural history cohorts, HIV animal studies, clinical trials, etc.) all he wants – without being able to produce a more parsimonious answer there’s really no contribution to be made, since no one finds it controversial that “having even more data would be nice”. The criteria that HN demands is the same criteria used by HIV/AIDS denialists (but he’s not one, he promises), anti-vaccinationists, and germ theory denialists.

It really comes down to the “show me the ONE paper that flawlessly proves evolution is real” argument that Creationists use. People have to be familiar with an entire body of literature, not a single study. Being an expert isn’t about what you know so much as being aware of what isn’t known, because you are intimately familiar with the total body of knowledge on a subject – this is why “armchair” experts so often fail, they don’t even realize how much they don’t know about a subject. He just reads the limitation sections and says “aha! this study is flawed” without stopping to think there might be another study that covers another study weakness, and another study to cover that study weakness, and…

One interesting observation is the absolute fanaticism HN has with zidovudine and its adverse events. I say this because I’ve dealt with HIV/AIDS denialists over a long time: The number one thing that switched a lot of people away from early skepticism (which early on was warranted – if a drug fails, it fails in the first five years on the market) was the continued release of more and more drugs beyond the nucleoside analogs which produces gradual improvements in care. It’s mental gymnastics to say that AZT works because it’s really an antibiotic – it becomes even more problematic to explain away how every other class of drugs, all of which hinge on a mechanism of action that presumes HIV leads to AIDS, are also all just collateral findings.

These days, a new patient presenting to the HIV clinic takes 1 pill a day and has fewer adverse events than the same patient decades ago. The most complicated thing to manage in these patients is usually making sure their other medications do not impact their HIV therapy and making sure they adhere to their medication. HN’s fascination with the era of giving people a high dose of AZT 4 times a day because that’s the only thing we know would work is almost 3 decades old – just like the rest of his knowledge on the subject.

Sorry for the drive-by potty mouth last night. I’m actually on holiday so you would think I could find something better to do. Booze and lucidity don’t correlated the way I feel like they do when I’m drunk.

Death rates were analyzed for over 20,000 HIV patients (no mention of whether they had AIDS or not) who were taking ART. Life expectancy was estimated based on the death rates during a 7 year period, and it was found that HIV patients taking ART will on average live past age 70.

I am very curious about how you can predict life expectancy based on death rates in a 7 year period. A person who is diagnosed with HIV is not expected to die within 7 years, for one thing. And side effects from ART might take decades to cause serious diseases.

This is the kind of confusing and unconvincing research I have seen since I started wondering about AIDS.

And someone linked an article claiming to show that HIV causes AIDS. Almost all the evidence in that article shows a correlation — which we already knew. HIV correlates with AIDS, partly because the definition of AIDS includes HIV infection.

The only thing mentioned that would count as evidence for causality is

“Chimpanzees experimentally infected with HIV have developed severe immunosuppression and AIDS. In ere combined immunodeficiency (SCID) mice given a human immune system, HIV produces similar patterns of cell killing and pathogenesis as seen in people. HIV-2, a less virulent variant of HIV which causes AIDS in people, also causes an AIDS-like syndrome in baboons. More than a dozen strains of simian immunodeficiency virus (SIV), a close cousin of HIV, cause AIDS in Asian macaques. In addition, chimeric viruses known as SHIVs, which contain an SIV backbone with various HIV genes in place of the corresponding SIV genes, cause AIDS in macaques.”

which admits there have not been accurate animal models until now. However, they had to damage the monkeys’ immune systems in order to cause them to have something resembling AIDS. I wonder if just damaging their immune systems would have been enough to cause AIDS, without the infection. That should have been a control group, but I guess they forgot.

HN, if you want to know how you can predict life expectancy based on death rates, why don’t you read the explanation of how they did it? They lay it right out there for everyone to read, if they want to.

You can not predict life expectancy based on death rates over a period of 7 years. Especially not when you are predicting the life expectancy of people who may have a potentially fatal disease with a latency period of 10 or 20 years.

“due to the increased risk of age-related co-morbidities among HIV-positive adults, it is possible life expectancy may plateau or decrease in the future; it will be important to monitor life expectancy estimates as more adults age with HIV.”

What they really mean by “age-related co-morbidities” is the long-term adverse effects of ARV drugs, such as heart disease, cancer and diabetes. These just happen to be common diseases of lifestyle and aging. It is highly misleading to imply that they are normal age and lifestyle-related diseases in HIV patients who have been taking ARV drugs for long periods.

But at least they admit their study tells us nothing about the real life expectancy of HIV patients on ART.

immune deficiency aka immunodeficiency (Wikipedia): is a state in which the immune system’s ability to fight infectious disease is compromised or entirely absent.

syndrome (dictionary): a group of symptoms which consistently occur together, or a condition characterized by a set of associated symptoms, e.g., a rare syndrome in which the production of white blood cells is damaged.

While there are multiple immune deficiency syndromes, some of which are acquired from an external source, AIDS refers to the specific immune deficiency syndrome that is acquired from the human immunodeficiency virus, acronym: HIV.

So, yes, an acquired immune deficiency syndrome can develop that is not caused by HIV. In such cases it is not called “AIDS” because this specific term is reserved for cases where the causative agent *is* HIV. This is why sexual health clinics provide “HIV tests” (tests for the causative agent), not “AIDS tests” (tests for the symptoms). Many people who are carriers of STIs (infectious agents) have no symptoms.

“Person-years for estimating mortality rates were accumulated from ART initiation (or January 1, 2000 for those who initiated prior to this date) until death date, loss to follow-up (defined as 6 months after the participant’s last CD4 cell count or viral load measurement), or December 31, 2007, whichever came first.”

Patients included in the earliest group initiated ART either between 2000 and 2002, OR before 2000.

“Importantly, our results are not confounded by previous antiretroviral use, as all participants were treatment-naive before initiating combination therapy.”

Yes they were all treatment-naive before initiating ART, but we don’t know when the earliest group initiated ART.

The length of time that a patient is HIV positive and is on ART is an important factor. However, that important information is not disclosed.

“In a sensitivity analysis restricted to only those who were observed to initiate ART during our study period (18,591 participants contributing 1,057 deaths), the overall unweighted mortality rate was 18.9 (95% CI: 17.8, 20.1) per 1,000 person-years.”

However, this restricted data was not used in the longevity estimations.

“Person-years for estimating mortality rates were accumulated from ART initiation (or January 1, 2000 for those who initiated prior to this date) until death date, loss to follow-up (defined as 6 months after the participant’s last CD4 cell count or viral load measurement), or December 31, 2007, whichever came first.”

They estimate mortality rates from ART initiation (or 1/1/2000), until death or loss to follow-up, or 12/31/2007.

So we know the starting point, at least for the second and third periods, but the ending point is NOT the end of the time period. We of course assume that it would be, but they don’t say. And if the second group spans 4 years while the third group spans 2 years, well then of course there will be a higher death rate in the second group.

It doesn’t seem possible that anything could be that stupid, so maybe this was explained somewhere and I just didn’t notice it.

It is also very strange that there is no breakdown of AIDS-related and non-AIDS-related cause of death.

The “less than” and “greater than” symbols didn’t show up in my comment.

You seem to be referring to table 4, where there is improvement in life expectancy with starting ART later. For all of those groups, those who start ART with CD4 greater than 350 have longer life expectancy than those who start ART with CD4 less than 350.

The life expectancy for IV drug users is independent of start date, doesn’t change that much for whites, increases a lot for non-whites. That probably reflects differential access to health care and racial prejudice. Those life expectancies are “normalized” for a 20 year old.

In all cases, CD4 level at ART start date is a very strong predictor of mortality.

The “death rates” being looked at are “deaths per 1,000 person years”. That death rate can be looked at over periods shorter than a person’s lifespan.

“As a member of The Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis… Johnson has argued that HIV does not cause AIDS.”[1]

Who is this expert named Johnson?

“Phillip E. Johnson (born June 18, 1940) is a retired UC Berkeley law professor and author who is considered the father of the intelligent design movement.
…
He was a co-founder of the Discovery Institute’s Center for Science and Culture (CSC) and is credited with establishing the wedge strategy, which aims to change public opinion and scientific consensus, and seeks to convince the scientific community to allow a role for God in scientific theory.
…
During the 1990s, Johnson engaged in AIDS denialism, challenging the scientific consensus by claiming that HIV tests do not detect HIV, AIDS statistics are grossly exaggerated and that HIV is not the cause of AIDS. He wrote several articles about the subject, including a piece in Reason magazine. He was one of the 12 founding members of The Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis and signatory to the group’s letter to the editor of Science asserting that HIV is only tautologically associated with AIDS and that HIV tests are inaccurate.”[1]

“HIV/AIDS denialism is the belief, contradicted by conclusive medical and scientific evidence, that human immunodeficiency virus (HIV) does not cause acquired immune deficiency syndrome (AIDS). Some denialists reject the existence of HIV, while others accept that HIV exists but say that it is a harmless passenger virus and not the cause of AIDS.
…
Denialists often use their critique of the link between HIV and AIDS to promote alternative medicine as a cure, and attempt to convince HIV-infected individuals to avoid ARV therapy in favour of vitamins, massage, yoga and other unproven treatments.”[2]

That HIV is the cause of AIDS satisfies both Hill criteria for causality and Koch’s postulates. If you are capable of understand that AIDS is clearly the consequence of an infectious disease, then you need to be able to provide some kind of alternative explanation to what the agent is other than HIV – simply saying “i dunno not hiv tho!” is simply not adequate. Said more bluntly, if you believe HIV does not cause AIDS, but smoking causes lung cancer, you are being intellectually inconsistent.

Also, and I’m repeating myself here, how are you concluding that ARV drugs “cause” all the adverse events you are mentioning? The data demonstrating a causal relationship that ARVs cause heart disease and cancer is far weaker than that demonstrating HIV is the cause of AIDS. From a clinical perspective, putting the drug on trial is perfectly fine because we prefer to apply a precautionary principle and assume the drug is the culprit of an adverse event unless proven otherwise, but from an epistemological standpoint it’s very sloppy. It’s perfectly fine to understand that HIV causes AIDS, while also accepting its association with adverse events is sufficient to presume causality; it’s problematic to deny HIV causes AIDS, but then shout to the heavens you know the drugs are causing all these adverse events.

“I do NOT think the drugs are causing all the adverse events, and I never said that.”

You literally said that ART therapy causes cancer and heart disease. Please do not backpedal.

Also, fyi – some further diving into the “heart disease” adverse event might be warranted. Sometimes it’s based on events (which tends to be the most concerning), but sometimes “heart disease” really means their lipids went up a little bit above an arbitrary threshold.

“That consensus idea does not have any convincing empirical support. People seem to believe in it merely because no one has a better idea.”

This statement seems profound at first, but it’s actually circular – ALL scientific conclusions are because “we don’t know have a better idea”; we also believe that smoking cause lung cancer, because we have “no better idea” what else could be causing so much cancer in patients who smoke. Again, there is nothing “special” about HIV/AIDS – it manages to satisfy the same reasoning that is common in determining causality in infectious disease. We work with the data we have, not the imaginary data that might some day exist in the future. This is why as new data emerges, science changes.

There is currently no evidence for an infectious agent other than HIV causing AIDS, and belief systems that emphasize AIDS is really caused by ART therapy (the P. Duesberg hypothesis) is nothing more thank crackpot masturbation that has literally resulted in dead bodies. I will at least give you credit for understanding AIDS is the consequence of an infectious disease, as it least implies you are mostly being a contrarian for the sake of being a contrarian and are not an outright lunatic like Duesberg.

“We don’t know everything, therefore we know nothing” works great… at doing nothing… and I suppose for someone who thinks scientific progress is a myth it’s at least consistent. This is sort of the fundamental difference between you and I imagine most readers on this blog: The idea of 2 steps forward and 1 step back is generally preferable to no steps anywhere for most of us.

That is interesting about Phillip Johnson. I wonder if his HIV/AIDS denialism has died down a bit within the intelligent design community because they self-censored and keep it well hidden, or it’s sincerely absconded because of the continued schism with the intelligent design the factions. I imagine it’s hard to run a ship that sails on the power of “scientists are fundamentally twisted creatures” and not end up with a bunch of extra lunatic anti-scientific baggage that many feel hurts the more direct cause of promoting Creationism in schools.

The crank magnetism is always amusing. Law professors who are evolutionary biologist by day and infectious disease researcher by night, oh my! Will wonders never cease?

The medical mainstream has settled on ARV drugs as an effective and relatively safe treatment for HIV/AIDS. The news media continually announces that AIDS is now a manageable chronic illness, not a death sentence, and that they represent a great triumph for modern medicine.

Steve N repeatedly echoes that claim.

THAT is what I believe is the result of wishful thinking, and also marketing propaganda.

And it is unfortunate because it prevents people from considering alternatives.

And it is often forgotten that most people with HIV never get tested. Therefore it is completely unknown how often HIV occurs without AIDS. The consensus says it is a very small percentage — but how could they possibly know?

Cigarette smoking and lung cancer is a convincing correlation because people who do not smoke are much less likely to get lung cancer. It is bi-directional.

The HIV and AIDS correlation only goes one way — people with AIDS usually have a positive HIV test.

Untreated HIV progresses to AIDS in an overwhelming amount of people. We know this because we have cohorts of people, who by their autonomy, decided not to undergo treatment and were tracked for 10+ years. The people who do not progress are a tiny fraction, and contrary to the idea that we think they are magical unicorns, we actually have accumulated a lot of research on their immune systems.

You are not proposing an alternative, you are proposing “watch and see” with the HIV/AIDS population. You might not agree with Duesburg, but you have similar solutions to the problem – go see how his public health policy worked out.

“The medical mainstream has settled on ARV drugs as an effective and relatively safe treatment for HIV/AIDS. The news media continually announces that AIDS is now a manageable chronic illness, not a death sentence, and that they represent a great triumph for modern medicine.” = True

“Steve N repeatedly echoes that claim.” = Also True

“THAT is what I believe is the result of wishful thinking, and also marketing propaganda.” = Complete and utter BS based on ignorance and confirmation bias.

“And it is unfortunate because it prevents people from considering alternatives.” = One of the most moronic things Hardnose has ever said.

Many, many, many people are still actively considering and working on alternatives. There is a TON of money still being spent on HIV/AIDS research. No one on this blog has ever said that the current ARV drugs are the ultimate solution — it is certainly not as good as an outright cure or a preventative vaccine for instance. And there is always the quest for faster/better/cheaper or less potential side effects.

Medical science is rarely able to offer a perfect solution. It is almost always a balancing act between benefits and potential risks. Nevertheless, most of the evidence strongly suggests that HIV patients live longer and healthier lives when treated with ARV. The majority of people that actually understand the research agree with this. Deal with it!!!

“There is a TON of money still being spent on HIV/AIDS research. No one on this blog has ever said that the current ARV drugs are the ultimate solution — it is certainly not as good as an outright cure or a preventative vaccine for instance.”

I think that’s an amusing irony – the elite controllers and long-term non-progressors… that HN thinks do not exist… are actually pretty important cornerstones of the ongoing struggle to find a vaccine that works reliably… which HN thinks we aren’t working on because we’re totally satisfied with ART.

In other words, 56.4% of previous comments are “Sophomoric High Intensity Trolling”. I’m as guilty of responding/wasting time as anyone, but I agree that most readers would concur that engaging HN directly is pointless. On the other hand, many of us believe it is not a good idea to leave obvious nonsense unchallenged.

I’d like to propose an intermediate approach. Rather than clogging up the thread with long, well-reasoned responses which we all know will do nothing to change HN’s mind, perhaps we could use a simple classification system. This could save space while still teaching novices how to recognize common logical errors.

For example, a short post that is clearly just the result of Confirmation bias would simply be labeled “Type C”.

A longer comment with elements of Begging the question, Unsubstantiated “facts” and a couple of Logical fallacies would be categorized by consulting the “Standardized Hardnose Incident Taxonomy” which would result in a fully qualified classification of BULLSHIT.

Now there’s a novel idea! I like it as it points out what he is doing while avoiding getting sucked into content.
I’ve always advocated ignoring such S.H.I.T. but at the same time did feel uneasy about leaving his nonsense totally unchallenged and leaving the novice to try to sort out the value, or lack of it, of his comments.
Have a go at it!

“Rather than clogging up the thread with long, well-reasoned responses which we all know will do nothing to change HN’s mind”
Reasoning would take too much effort. Easier to just call me a troll.

I’m going to give this a class of U for Unsubstantiated implication — for trying to imply that there haven’t already been hundreds, if not thousands, of well-reasoned, fully documented responses — exactly none of which have ever caused HN to admit he was wrong.

What you seem not to understand RickK is the need for comparison. We know that some HIV patients who refused ART died from AIDS. We do NOT know how many of them would have survived, or for how long, if they had taken ART.

We also do not know how many HIV patients who do take ART would have died from AIDS, or how long they would have survived, if they did not take ART.

When HIV patients on long-term ART die from non-AIDS causes, such as cancer or heart disease, we don’t know if their deaths might have been related to ART.

The critical information is missing, as far as I can tell, that would let is know if ART is safe and effective.

The official propaganda says that AIDS is no longer a death sentence and patients can live almost normal lives. We have no evidence for that claim.

What you seem not to understand RickK is the need for comparison. We know that some HIV patients who refused ART died from AIDS. We do NOT know how many of them would have survived, or for how long, if they had taken ART.
We also do not know how many HIV patients who do take ART would have died from AIDS, or how long they would have survived, if they did not take ART.
When HIV patients on long-term ART die from non-AIDS causes, such as cancer or heart disease, we don’t know if their deaths might have been related to ART.
The critical information is missing, as far as I can tell, that would let is know if ART is safe and effective.
The official propaganda says that AIDS is no longer a death sentence and patients can live almost normal lives. We have no evidence for that claim.

On the Standardized Hardnose Incident Taxonomy, this is a combination of Argument from Ignorance (because HN clearly has no idea how to understand and interpret the evidence) and a Grand Conspiracy (because it is impossible that none of the competent investigators could have failed to notice this supposed shortcoming).

I think I know what hn means: unless we reverse time and see what happens to the same individuals with and without HIV, with and without AIDS, and with and without ART (in every configuration), there is insufficient evidence to conclude that HIV causes AIDS, or make any inference about life expectancy on ART.

Oh, and new physics will one day explain effects that have not yet been demonstrated to exist.

In the undeveloped world, treatment for HIV is not available to everyone. In other words, not everyone who has HIV gets treated with ART. As a result, the death rates for HIV in the undeveloped world are higher than in the developed world where virtually everyone with HIV is treated.

“In the undeveloped world, treatment for HIV is not available to everyone. In other words, not everyone who has HIV gets treated with ART. As a result, the death rates for HIV in the undeveloped world are higher than in the developed world where virtually everyone with HIV is treated.”

That does count as some kind of evidence. But it’s really hard to know accurate death rates and causes in undeveloped areas.

The AIDS death rates could be higher in Africa because there is less knowledge about how to prevent transmission, and therefore more people get AIDS.

I also suspect that very large numbers of Africans are wrongly diagnosed as HIV positive. People of African descent are much more likely to be HIV positive, even if they are healthy.

“I think I know what hn means: unless we reverse time and see what happens to the same individuals with and without HIV, with and without AIDS, and with and without ART (in every configuration), there is insufficient evidence to conclude that HIV causes AIDS, or make any inference about life expectancy on ART.”

Reversing time would be the most effective approach. My time machine is broken right now though.

There are other ways. It is possible to be much more careful and skeptical when looking at evidence.

“Yes it does, that is well known and part of the mainstream consensus”

That’s… not the point. I promise I am more familiar with the adverse events of these drugs than you are. The point is that you are absolutely certain these are causal relationships when the evidence for that is weak in comparison. You are correct that the “mainstream consensus” accepts them as true, because as clinicians it’s important to take them seriously and apply extreme caution – but the evidence they are causal is modest. Again, this is an easy discussion for an “computer desk expert” to have since there’s nothing on the line – clinicians have to accept some tentative relationships as true because of the inherent ethics of practicing medicine.

You dodged the question: We have strong evidence HIV causes AIDS, and some moderate evidence it causes the adverse events you describe. Why do you find weaker evidence more compelling than strong evidence at establishing a causal relationship? That was kind of the entire point of evidence-based medicine – that not all evidence is created equal.

“I think I know what hn means: unless we reverse time and see what happens to the same individuals with and without HIV, with and without AIDS, and with and without ART (in every configuration), there is insufficient evidence to conclude that HIV causes AIDS, or make any inference about life expectancy on ART.”

Yeah, I get why people would want to do this experiment from a sort of mad scientist perspective, but I’m quite comfortable accepting some degree of uncertainty. It’s highly unfortunate that people like HN support denying treatment to those that would benefit, but I don’t think torturing humans in an unneeded clinical trial just to (potentially) satiate the knowledge of a denier is a worthwhile ethical endeavor. As I’ve said, there’s nothing wrong using observational data to answer observational questions – especially when you have *a lot* of observational data that all points to the same overall interpretation.

It’s a long road to a clinical trial. It needs to have some intellectual justification. I’m reminded of the poor monkeys murdered recently for the purposes of research funded by anti-vaccine groups – all to try and prove something wrong that was simply not controversial.

hardnose: “The sad news is, group think can lead to an expert consensus which is wrong.”

And this is the entirety of your “skeptical” argument about everything, ever.

Whether or not experts have been wrong in the past is essentially irrelevant to any specific question NOW. The only thing that matters is the current evidence.

And while “group think” may sometimes delay the inevitable, science has a damn good record of self-correction. So, unless you provide evidence that “at any given point in time”, group think causes the expert consensus to be wrong more often than not, then your entire point is worthless.

Simply saying “they might be wrong” will never prove you to be right. The scientific method, first and foremost, is all about verification. To that end, the greatest rewards (financial and reputation) always accrue to those who successfully challenge the orthodoxy.

No, I understood you. This is an ongoing fascination with HN. It’s actually a bit of a meta-discussion at this point – not just why he rejects that HIV is the cause of AIDS, but also why he *is* willing to accept that things like the trashy experiments by Sheldrake (telepathic dogs, ya’ll!) prove that ESP is real.

It’s the fundamental inconsistency in the definition of scientific evidence and how fluid it is for him that fascinates. I have no delusion that I’m going to change his mind on HIV/AIDS.

“The AIDS death rates could be higher in Africa because there is less knowledge about how to prevent transmission, and therefore more people get AIDS.”

Yes, and one way to reduce transmission is through ARVs.

Oh, wait, isn’t that strange? So HIV isn’t the cause of AIDS… but medications that hinge on a mechanism that presume HIV is the cause of AIDS not only reduces or prevents the progression to AIDS, but also reduce the transmission of AIDS to others?

It’s like saying most road traffic accidents (RTAs) are probably caused by wearing seat belts. Most people wear seat belts while in a car; the number of deaths and injuries has increased since the wearing of seat belts became mandatory decades ago; some of the people who have refused to wear a seat belt have died in a RTA. But, we don’t have nearly enough current evidence to support the scientific consensus that the wearing of seat belts increases longevity and/or quality of life because…

Many injuries, and some deaths, have been caused by both the wearing of seat belts and by the refusal to wear them, therefore we need much more evidence to decide whether or not wearing seat belts is causing the increase in death and injuries, rather than increasing longevity and quality of life of those who used them because they were coerced by science into using them.

This type of circular argument is indeed superficially stupid, but it does *not* result from stupidity. It is based on carefully-crafted wilful ignorance, combined with wilful obscurantism, for the sole purpose of trying to maximally leverage a hidden religious agenda [creationism] via causing the general public to increasingly mistrust science, and to gain increasing trust in those casting deep shadows of doubt on ‘materialistic science’ and its proponents. This was the whole raison d’être, and the current modus operandi, of the Dishonesty Institute and its associates.

I have refrained from responding from HN, but he is promoting a false perception on this topic of HIV treatment. I will address at a basic level

“I never said that. I don’t know the cause of AIDS.”

You seem to have a lot of opinions about something you obviously know very little about. You think this approach is skepticism, but it is not. Deferring to expertise is not appeal to authority, but intellectual humility. You need more of that.

“In my opinion no one should get ART unless they obviously have AIDS, not just HIV.”

And why is your opinion more than worthless? You are wrong to say this question has not been addressed in clinical trials. There are evidence from many sources to show why you are wrong on this topic, but the most recent study looking at this question is probably the best place to start. It addresses this very question and more:

Your use of personal incredulity and hyperskepticism to play games about what data say on all sorts of topics are played-out, boring, and pathetic. The consensus on topics do not rest on your ignorance (thankfully)

“That analogy is very stupid Pete A. We have data on accidents with or without seat belts.”

It is very stupid indeed to piss into the wind, hardnose, as I’ve explained to you in many previous comments on this website. I have also explained to you that it is so easy to rattle your cage because you are in one, and I am not.

We know enough to treat early. You know current ARVs regimens did not always exist, and since modern regimens have been around you don’t see what what seen in the 1980s. Rare cancers and infections, and increased person to person transmission. Who cares if a percentage of people (likely very rare) don’t get AIDS. That is the wrong question.

“They make the well-known mistake of not considering the possibility of over-diagnosis.”

Over-diagnosis of HIV? You make less sense than usual. Early treatment reduces transmission to others and prevents complications.

“A similar problem has been noticed recently with prostate cancer. Early screening has resulted in over-diagnosis and unnecessary (and sometimes harmful) treatment.”

No, that is not similar at all, and you don’t know what you are talking about. Prostate cancer is not always treated, but that is specific to a given person with a specific type/presentation of cancer. HIV has no such scenario, and if one was found, then the recommendations would change accordingly. You are just making shit up, as per usual.

See the link above. Early treatment has been shown to be beneficial many times in many ways, and you are wrong yet again.

Nope, when you disagree with the expert consensus on virtually everything discussed here, your beliefs are decidedly NOT mainstream.

“However, we do have an officially materialist perspective in medical research. So that is why I am here, trying to show that there is another side, and most people are on that other side.”

Isn’t it curious that the “materialist” medical treatments have a much, much higher success rate than anything from the other side. Regardless of how many people you feel are on “the other side”, it has nothing to do with whether their beliefs are true or not.

Also, I think it’s worth pointing out that the current consensus of treating everyone with HIV+ is quite new – it has developed very slowly over the years as more research has demonstrated a good risk/benefit ratio. Caution has been applied alongside the progress. HN’s view that the moment AZT hit the market we started giving it to every single person who has even looked at a person with AIDS is historically incorrect. The context of treating everyone is also paralleled with the improvement in therapy that is even more efficacious and has fewer adverse events – it’s not appropriate to do the benefit calculation now but keep the risk benefit calculation in the past.

They found a small benefit for starting ART earlier. And, as they said, 3 years tells you nothing about the long-term effects.

According to what I have read so far, the long-term effects tend to be very bad. However the drugs have supposedly become less toxic. Well no one really knows, and I think individual patients should make their own decisions, if only they could be told the truth. Instead, they are told AIDS is now merely a chronic disease and it’s possible to live almost normally thanks to ARV drugs.

There is no evidence for that, so people are deciding based on misinformation.

And poor illiterate HIV patients living in undeveloped places can’t make an informed decision.

Yes, and at some point it becomes unethical to randomize into groups when one is clearly superior. You are worrying about long term side effects when the life expectancy approaches HIV negative patients. Untreated patients still exist and do not do well.

Yet you want to withold treatment until people progress to AIDS.”In my opinion no one should get ART unless they obviously have AIDS, not just HIV.”

“You are worrying about long term side effects when the life expectancy approaches HIV negative patients.”

My original reason for commenting on this post was to show that there is no good evidence showing life expectancy for HIV patients. Someone linked to an article about some very poor research that supposedly showed this, but it does not, as I explained.

It is entirely a myth that ARV treatment lets HIV patients live relatively healthy almost normal lives.

All you did was explain that the study was worthless because it is an estimate – of course it’s an estimate, we don’t literally have ~75 years of raw data to work with.

The fact is we’re seeing people live 30+ years in the clinic now without clinical deterioration. You believe that this observation is meaningless, because HIV does not progress to AIDS and there might be a ton of people living 30+ years without treatment that do not progress – but this is simply wrong and you are totally ignorant of the actual data on long-term non-progressors, viremic controllers, and elite controllers. Which is odd, because you claim expertise in this area (“did your research”). I strongly encourage you to hit the indexing sites again – you are in an area of knowledge where you don’t even know how much you don’t know.

Even if you deny it, your argument is that unless we do an RCT for every single clinical question asked in every single permutation, then we cannot know anything. Using this criteria, any area of science can be denied, which is why “we don’t know everything, therefore we know nothing” is the rallying cry of every other denialist movement as well as this one.

This is one of a bunch of sites I checked, and it’s consistent with the rest. Sooo… some quite severe side effects are pretty common.

I hate conceding ground to hn, for all the reasons elucidated repeatedly, but a cursory check seems to confirm this at least. I’ll defer to those better informed than me if there’s something suspect about the info I linked to.

There’s nothing to concede because the position that ARV therapy isn’t sunshine and rainbows is not controversial. The controversial aspect is HN’s position that the risks of ARV therapy outweigh the risks of untreated HIV, and thus patients should be left to wait until they have very serious opportunistic infections before starting therapy (when ARV is least likely to be beneficial).

They used to say that about early diagnosis and treatment for prostate cancer. Then they realized that most early prostate cancer does not progress.

I suspect the same kind of thing will be recognized for HIV and ART. But it’s much more important since the side effects of ART can be lethal.

Keep in mind that ART can be enormously profitable for drug companies, and they are very likely to fund research. No, I don’t believe it’s a big conspiracy theory, but enormous profits can interfere with clear thinking.

I am unfamiliar with it because it does not exist. It is not possible to know how many people would be HIV positive if they were tested. Most people are not tested, if they are healthy and are not considered to be at risk.

For example, why do you think the HIV rates for American blacks and Africans is so high? Do you think their behavior is any riskier than the behavior of whites? I doubt it. There seem to be factors that cause false positive HIV tests in certain genetic groups.

hammyrex, I can understand why you don’t want to question policies you probably have been following for many years. But I hope some others here will at least start looking at the evidence, rather than having blind faith in the official consensus.

This is not a conclusion simply made on the basis of this discussion alone, but is the accumulation of unweaving your “expertise” in a wide range of subjects – i.e., literally every mainstream science that could even modestly be accused of having a reductionist approach is wrong, and HN the really smart computer programmer is right because he knows they are all wrong. A true modern Socrates.

The Royal Australian College of General Practitioners (RACGP) has never advocated screening for prostate cancer. This is because prostate cancer screening does not satisfy the criteria for a screening test. I believe that is the position also of the American equivalent. The drive for prostate cancer screening gas been largely by the media and special interest groups and has never been evidence based.